Telestroke Adoption Not Associated with Changes in Patient Outcomes

Telestroke adoption in hospitals did not produce any changes in patient outcomes or in stroke systems of care, according to a study from researchers at Harvard Medical School and other health systems. 

Telestroke is one of the more popular telemedicine services, due in large part to the results seen in health systems treating patients with the technology. Hospitals have implemented telestroke services to facilitate patient evaluations, boost time-sensitive stroke interventions - thus improving clinical outcomes and in some cases saving lives - and increase convenience for patients.

Researchers compared 593 hospitals that adopted telestroke between 2009 and 2016 with 593 control hospitals that did not offer telestroke services. They identified stroke and transient ischemic attack (TIA) patients using Inpatient and Outpatient Standard Analytic Files from 2008 to 2018 for Medicare beneficiaries.

The researchers looked at several different measures to determine the impact of telestroke adoption, including hospitals’ annual total stroke volumes, distance between patients’ homes and the hospitals, patient case mix, and the proportion of interhospital transfers.

The recorded data was from six months after the hospitals had implemented telestroke services to ensure the hospitals had time to become acquainted with the services and produce outcomes.

The telestroke hospitals and the control hospitals both had similar changes in their mean annual stroke volumes during the post-implementation period. The telestroke hospitals saw a decrease of 79.6 to 76.3 patients per year and the control hospitals saw a decrease of 78.8 to 75.5 patients.

The annual stroke volumes in the surrounding areas of the hospitals were similar as well, with around a three-patient decrease for both the telestroke and control hospitals. 

The distances that patients traveled by ambulance to the hospitals increased slightly from pre- to post-implementation in both hospital groups. Researchers measured patient case mix by looking at the 180-day mortality rates, which remained stable in the telestroke and control hospitals at around 17.4 percent.

The proportion of stroke patients who transferred to another hospital after telehealth implementation increased. The rate went from 5.7 percent to 6.8 percent in the telestroke hospitals and 4.8 percent to 5.8 percent in the control hospitals. 

Previous studies have revealed the opposite, with telestroke adoption showing an association with a decrease in the number of patients that transfer hospitals, the researchers noted.

The larger sample size of the Harvard study, the inclusion of temporal trends, and the likelihood of publishing studies with positive outcomes may have contributed to this difference.

The researchers noted that they were surprised by some aspects of the study results.

“Our expectation was that the implementation of telestroke would be associated with EMS professionals preferentially choosing newly capable telestroke hospitals and that this would be reflected in decreased ambulance transport distances and increased stroke volumes,” they wrote.

They noted that it’s possible that telestroke hospitals did not use the services frequently enough to produce a substantive change in outcomes. 

Although this study showed that telestroke was not significantly associated with patient destination or transfer volumes, telestroke services have improved health outcomes for individual patients.

Patients who have recently had a stroke may benefit from telehealth as well. Telehealth technology could help these patients manage their health and monitor their blood pressure in the months after their stroke.  

mHealth applications have also proven useful in identifying stroke symptoms in patients at the same accuracy level as an emergency room exam. 

“More work is required to assess what changes are needed in stroke systems of care—whether through more specific EMS protocols to ensure optimal prehospital patient sorting or more collaborative hospital networks to optimize interhospital sorting with respect to transfer and final destinations,” the study concluded.

Aside from Harvard, other researchers participating in the study are affiliated with Massachusetts General Hospital, the University of Vermont College of Medicine, Beth Israel Deaconess Medical Center, and the RAND Corporation.